Middle cerebral artery aneurysm surgery after stent misplacement: A case report

Abstract

Stent misplacement during endovascular treatment of middle cerebral artery (MCA) aneurysms can cause challenges and be problematic, if clipping becomes necessary. This article reports on a 56-year-old woman with an unruptured, multi-lobulated MCA aneurysm, whom primarily refused surgery; therefore, she was scheduled for stent-assisted coiling. After successful deployment of the stent, it unfortunately then became snagged by the microcatheter and was pulled backwards. The subsequent surgical procedure (i.e. clipping of the MCA aneurysm) was challenging, due to the position of the dislodged stent. Such as misplacement of the stent is rarely documented: It resulted in the difficult handling of a MCA aneurysm. Aneurysms of the MCA should primarily be considered for surgical clipping. In conclusion, an increased risk for eventual surgery should be considered, in cases where endovascular treatments with stents are performed.

Keywords: Adverse effects; aneurysm; case study; middle cerebral artery; stent misplacement; stent-assisted coiling; surgical clipping.

Figure 1.

MRI showing the flair signal around the aneurysm. MRI: magnetic resonance imaging.

Figure 2.

(a) Digital subtraction angiogram of the right MCA with the bifurcation aneurysm, after stent misplacement. (b) Post-stenting CT angiography, showing the unfavourable location of the distal ends of the stent. (c) Intraoperative photo showing of the location of the stent in the M1 with a thick red arrow, and the distal end of the stent exceeding the bifurcation, with the thin black arrow. (d) The 3-month follow-up 3D angiogram, showing the close relationship of the clip and stent after optimal vessel re-construction. 3D: 3-dimensional; CT: computed tomography; MCA: middle cerebral artery